Treatment Options for Lung Cancer

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The treatment that's right for you depends mainly on the type and stage of lung cancer. You may receive more than one type of treatment.

At any stage of lung cancer, care is available to control pain and manage breathing problems, to relieve the side effects of treatment, and to ease emotional concerns. You can get information about coping with symptoms and side effects at http://www.cancer.gov/cancertopics/coping.

Also, you can get information about coping from NCI's Cancer Information Service at 1–800–4–CANCER (1–800–422–6237). Or, chat using NCI's instant messaging service, LiveHelp (https://livehelp.cancer.gov).

Doctors Who Treat Lung Cancer

Your health care team will include specialists. There are many ways to find doctors who treat lung cancer:

Your doctor may be able to refer you to specialists.

You can ask a local or state medical society, or a nearby hospital or medical school for names of specialists.

Your health care team can describe your treatment options, the expected results of each option, and the possible side effects. Because cancer treatments often damage healthy cells and tissues, side effects are common. These side effects depend on many factors, including the type of treatment. Side effects may not be the same for everyone, and they may even change from one treatment session to the next.

You and your health care team can work together to develop a treatment plan.

Lung cancer is hard to control with current treatments. For that reason, many doctors encourage people with this disease to consider taking part in a research study (clinical trial) of new treatment methods. Research studies are an important option for people with any stage of lung cancer. See the Cancer Treatment Research section.

Questions you may want to ask your doctor about treatment options

What are my treatment options? Which do you recommend for me? Why?

What are the expected benefits of each kind of treatment?

What are the risks and possible side effects of each treatment? How can side effects be managed?

What can I do to prepare for treatment?

Will I need to stay in the hospital? If so, for how long?

What is the treatment likely to cost? Will my insurance cover it?

How will treatment affect my normal activities?

Would a treatment research study be right for me?

Second Opinion

Before starting treatment, you might want a second opinion about your diagnosis and treatment options. Some people worry that the doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it. Some insurance companies actually require a second opinion.

If you get a second opinion, the second doctor may agree with your first doctor's diagnosis and treatment recommendation. Or, the second doctor may suggest another approach. Either way, you have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you've looked at all of your options.

It may take some time and effort to gather your medical records and see another doctor. In most cases, it's not a problem to take several weeks to get a second opinion. The delay in starting treatment usually will not make treatment less effective. To make sure, you should discuss this delay with your doctor. Some people with lung cancer need treatment right away. For example, a doctor may advise a person with small cell lung cancer not to delay treatment more than a week or two.

Surgery

Surgery may be an option for people with early-stage lung cancer.

The surgeon usually removes only the part of the lung that contains cancer. Most people who have surgery for lung cancer will have the lobe of the lung that contains the cancer removed. This is a lobectomy. In some cases, the surgeon will remove the tumor along with less tissue than an entire lobe, or the surgeon will remove the entire lung. The surgeon also removes nearby lymph nodes.

After lung surgery, air and fluid will collect in the chest. A chest tube that was inserted during surgery will allow the fluid to drain. Also, a nurse or respiratory therapist will teach you coughing and breathing exercises. You'll need to do these exercises several times a day. The chest tube will be removed a few days after surgery.

The time it takes to heal after surgery is different for everyone. Your hospital stay may be a week or longer. It may be several weeks before you return to normal activities.

Medicine can help control your pain after surgery. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief.

Radiation Therapy

Radiation therapy is an option for people with any stage of lung cancer:

People with early lung cancer may choose radiation therapy instead of surgery.

After surgery, radiation therapy can be used to destroy any cancer cells that may remain in the chest.

In advanced lung cancer, radiation therapy may be used with chemotherapy.

Radiation therapy can be used to help shrink a tumor that is blocking the airway.

Radiation therapy can be used to help relieve pain from lung cancer that has spread to the bones or other tissues.

Radiation therapy is often used to treat lung cancer that has spread to the brain.

The radiation comes from a large machine. The machine aims high-energy rays at your body to kill cancer cells. The treatment affects cells only in the area being treated, such as the chest area.

You'll go to a hospital or clinic for treatment. Treatments are usually 5 days a week for about 6 weeks. Each treatment session usually lasts less than 20 minutes.

Although radiation therapy is painless, it may cause other side effects. The side effects depend mainly on how much radiation is given and the part of your body that is treated. Ask your health care team to describe the side effects that you might expect during or after radiation therapy.

Radiation therapy aimed at the chest may cause a sore throat, cough, or shortness of breath. When you try to swallow, you may feel a lump in your throat or burning in your chest or throat. Your health care team can suggest ways to manage these problems. The problems usually go away when treatment ends.

It's common for the skin in the chest area to become red and dry and to get darker. Sometimes the skin may feel tender or itchy. Check with your doctor before using lotion or cream on your chest. After treatment is over, the skin will heal.

You're likely to become tired during radiation therapy, especially in the later weeks of treatment. Although getting enough rest is important, most people say they feel better when they exercise every day. Try to go for a short walk, do gentle stretches, or do yoga.

Chemotherapy

Chemotherapy may be used alone, with radiation therapy, or after surgery.

Chemotherapy uses drugs to kill cancer cells. The drugs for lung cancer are usually given directly into a vein (intravenously) through a thin needle.

You'll probably receive chemotherapy in a clinic or at the doctor's office. People rarely need to stay in the hospital during treatment.

The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:

Blood cells: When drugs lower the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of the drug. There are also medicines that can help your body make new blood cells.

Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back after treatment, but the color and texture may be changed.

Cells that line the digestive tract: Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your health care team can give you medicines and suggest other ways to help with these problems.

Other possible side effects include hearing loss, joint pain, and tingling or numbness in your hands and feet.

When radiation therapy and chemotherapy are given at the same time, the side effects may be worse.

Your health care team can suggest ways to control many of these problems. Most go away when treatment ends.

Targeted Therapy

People with non-small cell lung cancer that has spread may receive a type of treatment called targeted therapy. Several kinds of targeted therapy are used for non-small cell lung cancer. One kind is used only if a lab test on the cancer tissue shows a certain gene change. Targeted therapies can block the growth and spread of lung cancer cells.

Depending on the kind of drug used, targeted therapies for lung cancer are given intravenously or by mouth. The drug enters the bloodstream and can affect cancer cells all over the body.

During treatment, your health care team will watch you for side effects. You may get a skin rash, diarrhea, or mouth sores, or you may feel very tired. Other possible side effects include shortness of breath, belly pain, high blood pressure, vomiting, and swollen feet and hands. The side effects usually go away after treatment ends.

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